2010 Food, Body Image, and
Eating Disorders in the Jewish Community
October 27, 2010
Name:____________________________________________Credentials:_______________________
Organization:_______________________________________________________________________
Work Address:
_____________________________________________________________________
City, State, ZIP:_____________________________________________________________________
Work Phone: (______)_____________________Home Phone: (______)________________________
Fax: (______)__________________________E-Mail:
______________________________________
Seminar
Cost (includes morning refreshments): $65; $25 for students
Enclosed is a check or money order in the amount of
$_____________________.
I will attend the tour of The
Please make checks payable to The Renfrew Center Foundation and
send to:
Debbie Lucker
The
475 Spring Lane
Or fax registration with credit card information to Debbie
Lucker at 215-482-2695.
Please confirm receipt of fax.
Below is my credit card information authorizing payment to be
charged to my account.
(Only those cards listed below are accepted.)
Credit Card # _________________________________________ Exp.
Date: ________/_________
Sec. Code ___________________ Amount
Charged: $_____________
Check card used: ❏ AMEX ❏ DISCOVER ❏ MASTERCARD ❏ VISA
Signature: ____________________________________________ Date:
______________________
For more information, please call Debbie Lucker at
1-877-367-3383 or e-mail at dlucker@renfrew.org
Please note: Phone registrations will not be accepted. Refunds
(minus a $50 administrative fee) will be made for cancellation up to 14 days prior
to seminar. No refunds will be made after such time.